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Natural history of grade 1 ascites in patients with liver cirrhosis

  • Theodorakopoulos, Theodoros1
  • Kalafateli, Maria1
  • Kalambokis, Georgios N.2
  • Samonakis, Dimitrios N.3
  • Aggeletopoulou, Ioanna1
  • Tsolias, Chrysostomos1
  • Mantaka, Aikaterini3
  • Tselekouni, Paraskevi1
  • Vourli, Georgia4
  • Assimakopoulos, Stelios F.5
  • Gogos, Charalampos5
  • Thomopoulos, Konstantinos1
  • Milionis, Haralampos2
  • Triantos, Christos1
  • 1 Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras (Theodoros Theodorakopoulos, Maria Kalafateli, Ioanna Aggeletopoulou, Chrysostomos Tsolias, Paraskevi Tselekouni, Konstantinos Thomopoulos, Christos Triantos)
  • 2 Division of Internal Medicine, First Division of Internal Medicine and Liver Unit, Medical School, University of Ioannina, Ioannina (Georgios N. Kalambokis, Haralampos Milionis)
  • 3 Division of Gastroenterology and Hepatology, University Hospital of Crete, Heraklion, Crete (Dimitrios N. Samonakis, Aikaterini Mantaka)
  • 4 Division of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens (Georgia Vourli)
  • 5 Division of Internal Medicine, University Hospital of Patras (Stelios F. Assimakopoulos, Charalampos Gogos), Greece
Published Article
Annals of Gastroenterology
Hellenic Society of Gastroenterology
Publication Date
Nov 20, 2020
DOI: 10.20524/aog.2020.0553
PMID: 33414628
PMCID: PMC7774664
PubMed Central


Background No evidence is available on the natural history of grade 1 ascites and its progression to grade 2/3 in patients with liver cirrhosis. The aim of the current study was to address this issue, to assess the development of main comorbid disorders closely related to ascites progression, and to identify the predictive factors for survival in this setting. Methods Consecutive Caucasian cirrhotic patients with grade 1 ascites were retrospectively analyzed. None of patients was under treatment with diuretics at diagnosis. Control groups consisted of 145 cirrhotics with grade 2/3 ascites and 175 cirrhotics without ascites. Results Diuretics were initiated in 58 patients with grade 1 ascites at baseline by the attending physician. At the last follow up, 29 patients had no ascites, 33 patients had grade 1 and 38 patients had grade 2/3 ascites. No variable was found to be an independent predictor of grade 2/3 ascites. Seven patients developed spontaneous bacterial peritonitis while under treatment with diuretics; at that time only 1 patient had grade 1 ascites. The mortality rate was similar among all examined groups. Conclusions This study suggests that the presence of grade 1 ascites does not constitute a precursor of grade 2/3 ascites in patients with cirrhosis. Thus, patients with grade 1 ascites do not require specific treatment with diuretics.

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